Abstract
Introduction
Fragility fractures are a frequent presentation to the acute medical take. Defined as a fracture following a fall from standing height or less[1], they represent up to 10% of acute admissions. Despite this, we identified no standardised protocol for commencing bone protection in our unit. Our project aimed to improve the management of bone health in this cohort.
Methods
Data was collected across an 18-week audit cycle, with 6 weeks of baseline data collected prior to any interventions. Patients with radiologically proven fractures sustained from standing height or less were included. The following endpoints were used: FRAX score calculation, commencement on bisphosphonate therapy (if no contra-indications) and referral for out-patient follow-up. We implemented several interventions including formal departmental education and the introduction of a digital SmartPhrase.
Results
22 and 25 patients were included in the baseline and post-intervention analysis, respectively. Pre-intervention data: 13.6% (3/22) had a FRAX score calculated during their admission. 77.3% (17/22) were identified as being appropriate to commence bisphosphonate therapy, however, only 11.8% (2/17) were initiated on therapy. 23.5% (4/17) were referred for out-patient follow-up. Post-intervention data: FRAX scores were calculated for 48.0% (12/25) of patients. 72.0% (18/25) were identified as being appropriate for bisphosphonate therapy, with 77.8% (14/18) initiated on therapy. 55.6% (10/18) were referred for out-patient follow-up.
Conclusions
Our baseline data showed poor management of fragility fractures and with simple interventions and incorporating digital technology, we have demonstrated an improvement across all endpoints. Going forward we hope our QIP will inform the creation of a formal trust-wide policy. Overall, we have learned that bone health is an aspect of the comprehensive geriatric assessment that we can make a significant contribution to in acute medicine.
Comments
QIP drives positive changes
This is a good demonstration of incorporating bone health in CGA especially for geriatric fragility fracture cohorts. We have similar challenges in our local area since it is "hit or miss" with our primary care colleagues regarding bone health review, we recently adopted the "capture the fracture" approach, expanded our orthogeriatrics service to include major osteoporotic fractures so right on admission there is fragility fracture bone health management. Your QIP will help prevent fracture admissions and helps those frail patients who are at risk of falls. Well done!